It looks like euthanasia to me
lain Duncan Smith on the threat to life contained in the Mental Capacity Bill
When a patient is denied food and water his death is a horrible process. Before he dies he will suffer seizures, heaving, nosebleeds, cracked lips and a parched, gradually blackening tongue. The patient does not simply 'slip away quietly', his death becomes a terrible ordeal for relatives.
For the vast majority of people the idea that a civilised country could consider dehydrating and starving patients is unthinkable. But that is exactly what we are doing now. If the Mental Capacity Bill now before Parliament goes through, the possibility of withdrawal of food and water will be extended to patients who, through illness or accident, have lost basic mental functions. The Bill will produce the worst of all worlds. Not only will people be sentenced to death but they will die in the most horrible of ways.
The Mental Capacity Bill does contain a number of worthwhile provisions. These have emerged from many years of consultation and I can understand why groups representing people with disabilities would like to see the Bill become law, However, there is a fatal flaw at its heart: the licence to withhold tube-delivered food and water from a patient who would otherwise live. The government protests that this is not euthanasia. I cannot agree. It is a death sentence for the patients in question. Even advocates of euthanasia agree. Dr Helgha Kuhse, the former president of a consortium of right-to-die organisations, wrote: 'If we can get people to accept the removal of all treatment and care — especially the removal of food and fluids — they will see what a painful way this is to die and . . . they will accept the lethal injection.'
Last week's Commons debate on the Mental Capacity Bill was Parliament at its best — a rare occasion when people on both sides of the House were honestly w•restling with hugely serious issues. Everyone was aware that we would be passing legislation that would have a decisive influence on whether and how very vulnerable peoples' lives would end.
The House was moved to silence by the Labour MP for Crosby, Claire CurtisThomas. Her powerful story of her own mother's final months exposed the cornplete inadequacy of the government's proposed safeguards. Ms Curtis-Thomas's mother had had a second massive stroke. The daughter spent day after day at the hospital bedside of her mother. After she had recovered from her first stroke she had told her daughter that if she was struck again she wanted to leave 'this world as quickly as possible'.
Some weeks after this second stroke Ms Curtis-Thomas was approached by doctors to discuss life-and-death decisions about feeding her mother. Without food she would die more quickly. With food she would stay alive for longer. Claire CurtisThomas was desperate to confirm whether or not her mother really wanted a rapid end to her life. At the eleventh hour her mother began to communicate through the raising of an eyebrow and the blink of an eye. Through this method of contact, authenticated by a nurse, the mother let it be known that she did want to stay alive and continue to receive food. She had changed her mind at the last moment.
The Mental Capacity Bill does contain an attempt to protect patients from these sorts of dangers. A patient can appoint a lasting attorney to make medical and other decisions if he or she becomes incapacitated. But it is one of a number of devices the government is relying on to protect mentally incapacitated patients that have already been tested and found wanting in other countries.
There is the horrifying story of Marjorie Nighbert from Florida. Another stroke victim, Ms Nighbert found herself disabled but not terminally ill. She could not chew or swallow and was provided with a feeding tube. Her brother, however, insisted that food and fluids be withdrawn. That was her wish, he said, remembering a comment she had made after watching a distressing television programme about another person's end-of-life tragedy.
As Ms Nighbert was slowly being dehydrated to death she began to show signs of extraordinary stress, and nurses believed that she was signalling that she did want food and water. Distraught nurses fed her small amounts. A court eventually decided, however, that she was not competent to rescind the instruction given to her brother. The dehydration process continued until she died.
I am very uneasy about the reliability of powers of attorney or advance directives. The patient may have changed his mind about wanting to die but may not be able to communicate this. Advanced directives could, for example, be made in a depressed state. I have been struck by the evidence showing how a majority of suicides and episodes of self-harm are a cry for help. People express their desperation in acts of self-harm, because they cannot, at the time, seek or find the help they need. The civilised, compassionate response to 'I want to die' is 'Please, tell me what's the matter'.
Polls show that the vast majority of doctors do not support any kind of euthanasia. Under this Bill doctors could be compelled to end the patient's life by denying him life's essentials. It is unreasonable to place the burden of implementing a living will, or power of attorney decision, on to already overworked, hard-pressed doctors and nurses.
As a society we have some big choices ahead of us. How we treat the old and sick — just as how we treat every vulnerable person — says a great deal about the kind of people we are. If we move towards right to die many very old and chronically disabled people will soon feel pressured to die. They might express a wish to die in an advance directive, but the real motivation could he a deep-seated sense of being a burden to their loved ones and to the wider society. The only way we can protect the most vulnerable from such a feeling is to build a society that lives by a higher duty — an absolute duty to care.
The debate over euthanasia is shrouded in confusion. And it is a debate that is not helped by scare stories propagated by the pro-euthanasia movement about exceptional end-of-life experiences. Fortunately Britain's hospice movement and our global pre-eminence in palliative medicine means that few people die in pain. I don't think anyone should be kept alive longer than is proper. It is already legal to allow a dying person to 'die peacefully' and no one challenges that.
I am not a member of any group associated with these life-and-death issues. Yet I am opposed to euthanasia. But whatever your instinctive view, consider what MPs are being asked to sanction. For those who cannot communicate and who are out of sight, the possibility is that they could be starved or dehydrated to death.
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